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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (02) : 221 -226. doi: 10.3877/cma.j.issn.1674-6902.2026.02.006

论著

75例急性呼吸窘迫综合征的临床特征及预后分析
甘志新1, 胡雍军2, 杨倩1, 胡明冬3,†()   
  1. 1830000　乌鲁木齐，新疆军区总医院心血管内科
    2844000　喀什，中国人民解放军第947医院心肾内科
    3400037　重庆，陆军（第三）军医大学第二附属医院老年与特勤医学科
  • 收稿日期:2025-11-11 出版日期:2026-04-25
  • 通信作者: 胡明冬
  • 基金资助:
    国家重点研发计划课题资助(2020YFC2008903)

Analysis of clinical characteristics and prognosis in 75 patients with acute respiratory distress syndrome

Zhixin Gan1, Yongjun Hu2, Qian Yang1, Mingdong Hu3,†()   

  1. 1Department of Cardiology, General Hospital of Xinjiang Military Command, Urumqi 830000, China
    2Department of Cardiorenal Medicine, The 947th Hospital of the People′s Liberation Army, Kashgar 844000, China
    3Department of Geriatrics and Secret Service Medicine, Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
  • Received:2025-11-11 Published:2026-04-25
  • Corresponding author: Mingdong Hu
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引用本文：

甘志新, 胡雍军, 杨倩, 胡明冬. 75例急性呼吸窘迫综合征的临床特征及预后分析[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(02): 221-226.

Zhixin Gan, Yongjun Hu, Qian Yang, Mingdong Hu. Analysis of clinical characteristics and prognosis in 75 patients with acute respiratory distress syndrome[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(02): 221-226.

目的

分析急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)患者的临床特征及预后。

方法

回顾性收集2020年12月至2024年1月陆军(第三)军医大学第二附属医院收治的75例ARDS患者临床资料，根据生存情况分组，生存者41例为对照组，死亡者34例为观察组。比较两组基本信息、实验室指标、肺损伤预测评分(lung injury prediction score, LIPS)、急性生理学与慢性健康状况评分(acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ)。采用Logistic回归分析ARDS预后危险因素，通过受试者工作特征曲线(receiver operating characteristic, ROC)预测ARDS预后。

结果

75例ARDS患者中严重肺部感染46例(61.33%)，重型急性胰腺炎19例(25.33%)，脓毒症5例(6.67%)，严重创伤5例(6.67%)。生存41例(54.67%)，死亡34例(45.33%)。观察组年龄(63.06±13.52)岁、APACHE Ⅱ评分(14.82±5.83)分、LIPS评分(6.28±1.72)分、氧合指数(145.76±72.24)与对照组(54.20±13.59)岁、APACHE Ⅱ评分(7.22±3.24)分、LIPS评分(4.63±1.36)分、氧合指数(205.27±61.30)差异有统计学意义(P<0.05)。Logistic回归分析显示，年龄(OR: 1.080，95%CI：1.011~1.153)、LIPS评分(OR: 2.245，95%CI: 1.252~4.027)、APACHE Ⅱ评分(OR：1.263，95%CI：1.067~1.496)和氧合指数(OR：0.988，95%CI: 0.977~1.000)是ARDS预后的危险因素。ROC曲线下面积(area under the curve, AUC)显示，APACHE Ⅱ评分联合氧合指数AUC为0.888，约登指数为0.707，敏感性为0.853，特异性为0.854。

结论

APACHE Ⅱ评分联合氧合指数可预测ARDS患者预后，有助于早期识别高危患者，为针对性救治提供依据。

关键词: 急性呼吸窘迫综合征, 肺损伤预测评分, 急性生理与慢性健康评分Ⅱ, 氧合指数, 预后
Objective

To analyze the clinical characteristics and prognosis of patients with acute respiratory distress syndrome (ARDS).

Methods

The clinical data of 75 patients with ARDS admitted to the Second Affiliated Hospital of Army Medical University from December 2020 to January 2024 were retrospectively collected. They were grouped according to prognosis. 41 cases survived as the control group and 34 cases died as the observation group. Compare the basic information, laboratory indicators, lung injury prediction score (LIPS) and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)of the two groups. Logistic regression was used to analyze the prognostic risk factors of ARDS, and the prognosis of ARDS was predicted by the receiver operating characteristic (ROC) curve.

Results

Among 75 patients with ARDS, severe pulmonary infection in 46 cases (61.33%), severe acute pancreatitis in 19 cases (25.33%), sepsis in 5 cases (6.67%), and severe trauma in 5 cases (6.67%). Forty-one cases (54.67%) survived and 34 cases (45.33%) died. The age of the observation group was (63.06±13.52) years old, and APACHE The Ⅱ score (14.82±5.83) points, LIPS score (6.28±1.72) points, and oxygenation index (145.76±72.24) were statistically different from those of the control group (54.20±13.59) years old, (7.22±3.24) points, (4.63±1.36)points, and (205.27±61.30) (P<,0.05). Logistic regression analysis showed that age (OR: 1.080, 95%CI: 1.011~1.153), LIPS score (OR: 2.245, 95%CI: 1.252~4.027), APACHE Ⅱ score (OR: 1.263, 95%CI: 1.067~1.496) and oxygenation index (OR: 0.988, 95%CI: 0.977~1.000) were risk factors for the prognosis of ARDS. the area under the ROC curve (AUC) showed that the AUC of the APACHE Ⅱ score combined with the oxygenation index was 0.888, the Youden index was 0.707, the sensitivity was 0.853, and the specificity was 0.854.

Conclusion

The APACHE Ⅱ score combined with the oxygenation index can predict the prognosis of ARDS patients, which is helpful for the early identification of high-risk patients and provides a basis for targeted intervention.

Key words: Acute respiratory distress syndrome, Lung injury prediction score, Acute physiology and chronic health score Ⅱ, Oxygenation index, Prognosis
表1 两组ARDS患者临床特征(±s)
临床特征 观察组(n＝34) 对照组(n＝41) t/Z/χ2值 P值
年龄(岁) 63.06±13.52 54.20±13.59 2.818 0.006
住院时间(d) 13.77±11.46 24.66±23.52 2.614 0.011
BMI(kg/m2) 24.21±3.64 24.76±4.16 0.480 0.633
体表面积(m2) 1.6±0.19 1.71±0.21 1.981 0.053
LIPS(分) 6.28±1.72 4.63±1.36 4.620 0.000
APACHEⅡ(分) 14.82±5.83 7.22±3.24 6.786 0.000
氧合指数(mmHg) 145.76±72.24 205.27±61.3 3.86 0.000
机械通气时间(d) 11.15±8.76 7.83±8.80 1.629 0.108
WBC(109/L) 12.13±6.92 10.87±6.12 0.836 0.406
总蛋白(g/L) 57.95±10.2 59.9±12.32 0.735 0.465
白蛋白(g/L) 31.57±5.51 32.17±4.9 0.504 0.616
CRP(mg/L) 120.47±75.56 128.18±102.53 0.364 0.717
PCT(ng/ml) 11.65±26.54 6.04±13.63 1.115 0.270
总胆红素(μmol/L) 19.85±24.83 27.17±37.27 0.979 0.331
直接胆红素(μmol/L) 7.42±9.33 12.20±23.36 1.121 0.266
CK(U/L) 121.42±233.58 224.02±258.53 1.641 0.106
CKMB(U/L) 19.38±18.44 18.37±12.76 0.258 0.797
LDH(U/L) 527.78±302.89 688.59±863.06 0.938 0.352
肌酐(μmol/L) 101.09±76.79 101.76±112.18 0.029 0.977
ESR(mm 1 h) 48.51±32.69 46.98±33.85 0.174 0.862
尿素(mmol/L) 10.37±7.68 9.4±8.61 0.481 0.632
尿酸(μmol/L) 277.52±126.52 264.08±158.72 0.398 0.692
pH 7.40±0.75 7.40±0.90 0.146 0.885
GLU(mmol/L) 9.53±4.21 10.45±5.21 0.824 0.412
LAC(mmol/L) 1.84±1.50 1.73±1.01 0.382 0.703
BNP(pg/ml) 390.70±705.11 168.64±335.83 1.646 0.107
cTnI(ng/ml) 0.13±0.38 0.06±0.08 0.969 0.336
PT(s) 13.53±3.67 14.12±8.07 0.395 0.694
APTT(s) 34.4±10.57 30.68±5.05 1.886 0.066
TT(s) 16.15±3.84 14.58±3.07 1.970 0.053
D-D(mg/L) 4.88±6.28 3.14±5.12 1.319 0.191
图1 典型ARDS患者CT影像学图。图A为对照组患者，CT示双肺多发斑片状、结节状高密度影，沿支气管血管束分布，部分病灶融合，可见"树芽征"；图B为对照组患者，CT示右肺下叶可见孤立性结节灶，边缘欠规整，双肺散在纤维条索影；图C为观察组患者，CT示双肺病变范围广泛，呈弥漫性磨玻璃影与实变影，部分区域呈"铺路石征"；图D为观察组患者，CT示双肺广泛蜂窝状改变、网格影，以胸膜下区为主，提示肺间质纤维化
表2 二元Logistic回归分析ARDS预后危险因素
危险因素 单因素Logistics回归 多因素Logistics回归
OR(95%CI) P值 OR(95%CI) P值
年龄 1.049(1.012~1.088) 0.009 1.080(1.011~1.153) 0.005
LIPS 1.997(1.381~2.889) 0.000 2.245(1.252~4.027) 0.002
APACHE Ⅱ 1.445(1.219~1.713) 0.000 1.263(1.067~1.496) 0.003
氧合指数 0.987(0.980~0.995) 0.001 0.988(0.977~1.000) 0.031
表3 ARDS预后的ROC曲线分析
变　量 AUC 标准误 P值 95%CI 截断值 约登指数 敏感性 特异性
年龄 0.682 0.062 0.007 0.560~0.804 55.00 0.350 0.765 0.585
LIPS 0.771 0.055 0.000 0.663~0.879 4.25 0.448 0.912 0.537
APACHE Ⅱ 0.878 0.040 0.000 0.800~0.957 10.5 0.638 0.735 0.902
氧合指数 0.747 0.060 0.000 0.630~0.864 166.5 0.428 0.780 0.647
APACHE Ⅱ＋LIPS 0.897 0.037 0.000 0.825~0.970 0.279 0.687 0.882 0.805
APACHE Ⅱ＋氧合指数 0.888 0.040 0.000 0.810~0.966 0.342 0.707 0.853 0.854
APACHE Ⅱ＋LIPS＋氧合指数 0.900 0.037 0.000 0.828~0.973 0.255 0.697 0.941 0.756
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